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To test the broader specificity of elevated IgG-VN-Glyc, we studied patients with distinct subtypes of myasthenia gravis (MG), a B cell\u2013mediated autoimmune disease. Our experimental design focused on examining the B cell repertoire and total IgG. It specifically included adaptive immune receptor repertoire sequencing to quantify and characterize N-linked glycosylation sites in the circulating BCR repertoire, proteomics to examine glycosylation patterns of the total circulating IgG, and an exploration of human-derived recombinant autoantibodies, which were studied with mass spectrometry and Ag binding assays to respectively confirm occupation of glycosylation sites and determine whether they alter binding. We found that the frequency of IgG-VN-Glyc motifs was increased in the total BCR repertoire of patients with MG when compared with healthy donors. The elevated frequency was attributed to both biased V gene segment usage and somatic hypermutation. IgG-VN-Glyc could be observed in the total circulating IgG in a subset of patients with MG. Autoantigen binding, by four patient-derived MG autoantigen-specific mAbs with experimentally confirmed presence of IgG-VN-Glyc, was not altered by the glycosylation. Our findings extend prior work on patterns of Ig V region N-linked glycosylation in autoimmunity to MG subtypes.<\/jats:p>","DOI":"10.4049\/jimmunol.2100225","type":"journal-article","created":{"date-parts":[[2021,9,20]],"date-time":"2021-09-20T16:06:02Z","timestamp":1632153962000},"page":"2005-2014","source":"Crossref","is-referenced-by-count":27,"title":["Elevated N-Linked Glycosylation of IgG V Regions in Myasthenia Gravis Disease Subtypes"],"prefix":"10.1093","volume":"207","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7764-6529","authenticated-orcid":false,"given":"Caleigh","family":"Mandel-Brehm","sequence":"first","affiliation":[{"name":"Department of Biochemistry and Biophysics, University of California San Francisco , San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0107-4103","authenticated-orcid":false,"given":"Miriam L","family":"Fichtner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yale University School of Medicine , New Haven, CT"},{"name":"Department of Immunobiology, Yale University School of Medicine , New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8494-082X","authenticated-orcid":false,"given":"Ruoyi","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Immunobiology, Yale University School of Medicine , New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9178-2252","authenticated-orcid":false,"given":"Valerie J","family":"Winton","sequence":"additional","affiliation":[{"name":"Proteomics Center of Excellence, Northwestern University , Evanston, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara E","family":"Vazquez","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Biophysics, University of California San Francisco , San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0234-4790","authenticated-orcid":false,"given":"Minh C","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Immunobiology, Yale University School of Medicine , New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0411-4307","authenticated-orcid":false,"given":"Kenneth B","family":"Hoehn","sequence":"additional","affiliation":[{"name":"Department of Pathology, Yale University School of Medicine , New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8815-3372","authenticated-orcid":false,"given":"Neil L","family":"Kelleher","sequence":"additional","affiliation":[{"name":"Department of Chemistry, Chemistry of Life Processes Institute, Proteomics Center of Excellence at Northwestern University , Evanston, IL"},{"name":"Department of Molecular Biosciences, Chemistry of Life Processes Institute, Proteomics Center of Excellence at Northwestern University , Evanston, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J","family":"Nowak","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yale University School of Medicine , New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4957-1544","authenticated-orcid":false,"given":"Steven H","family":"Kleinstein","sequence":"additional","affiliation":[{"name":"Department of Immunobiology, Yale University School of Medicine , New Haven, CT"},{"name":"Department of Pathology, Yale University School of Medicine , New Haven, CT"},{"name":"Interdepartmental Program in Computational Biology and Bioinformatics, Yale University , New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8705-5084","authenticated-orcid":false,"given":"Michael R","family":"Wilson","sequence":"additional","affiliation":[{"name":"Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco , San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph L","family":"DeRisi","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Biophysics, University of California San Francisco , San Francisco, CA"},{"name":"Chan Zuckerberg Biohub , San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7056-419X","authenticated-orcid":false,"given":"Kevin C","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yale University School of Medicine , New Haven, CT"},{"name":"Department of Immunobiology, Yale University School of Medicine , New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,10,15]]},"reference":[{"key":"2025022610321764100_r1","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.4049\/jimmunol.1502136","article-title":"The Emerging Importance of IgG Fab Glycosylation in Immunity","volume":"196","author":"van de Bovenkamp","year":"2016","journal-title":"J. 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Dis."},{"key":"2025022610321764100_r11","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.bbagen.2005.11.021","article-title":"Differential glycosylation of polyclonal IgG, IgG-Fc and IgG-Fab isolated from the sera of patients with ANCA-associated systemic vasculitis","volume":"1760","author":"Holland","year":"2006","journal-title":"Biochim. Biophys. Acta"},{"key":"2025022610321764100_r12","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1471-2172-13-10","article-title":"Influence of variable domain glycosylation on anti-neutrophil cytoplasmic autoantibodies and anti-glomerular basement membrane autoantibodies","volume":"13","author":"Xu","year":"2012","journal-title":"BMC Immunol."},{"key":"2025022610321764100_r13","doi-asserted-by":"crossref","first-page":"e0213215","DOI":"10.1371\/journal.pone.0213215","article-title":"Immunoglobulins G from patients with ANCA-associated vasculitis are atypically glycosylated in both the Fc and Fab regions and the relation to disease activity","volume":"14","author":"Lardinois","year":"2019","journal-title":"PLoS One"},{"key":"2025022610321764100_r14","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1042\/bj3140621","article-title":"Site-specific glycosylation of human immunoglobulin G is altered in four rheumatoid arthritis patients","volume":"314","author":"Youings","year":"1996","journal-title":"Biochem. 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Immunol."},{"key":"2025022610321764100_r24","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1002\/mus.25973","article-title":"B cells in the pathophysiology of myasthenia gravis","volume":"57","author":"Yi","year":"2018","journal-title":"Muscle Nerve"},{"key":"2025022610321764100_r25","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1038\/85520","article-title":"Auto-antibodies to the receptor tyrosine kinase MuSK in patients with myasthenia gravis without acetylcholine receptor antibodies","volume":"7","author":"Hoch","year":"2001","journal-title":"Nat. Med."},{"key":"2025022610321764100_r26","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1002\/ana.20061","article-title":"Detection and characterization of MuSK antibodies in seronegative myasthenia gravis","volume":"55","author":"McConville","year":"2004","journal-title":"Ann. 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